Easier cisplatin regimen for advanced cervical cancer appears less effective
NEW YORK (Reuters Health) - Women with locally advanced cervical cancer undergoing radiation therapy have better survival when they receive concomitant cisplatin-based treatment in a 5-day inpatient regimen rather than an easier weekly outpatient protocol, according to New York-based researchers.
"Because of the ease of weekly dosing and the lower cost of outpatient cisplatin administration in combination with radiation therapy for the treatment of locally advanced cervical cancer," Dr. Mark H. Einstein told Reuters Health, there has been "a trend to use outpatient weekly cisplatin despite no randomized, controlled comparison trials showing equivalency to inpatient 5-day regimens."
In the January issue of Cancer, Dr. Einstein of Montefiore Medical Center, the Bronx and colleagues note that cisplatin administration concomitant with radiotherapy for the treatment of locally advanced cervical cancer has evolved from a 5-day per 21-day inpatient regimen developed in the mid-1980s to a weekly outpatient regimen.
To examine possible differences in outcome, the researchers compared data on 50 patients who underwent the 5-day regimen with cisplatin at 20 mg/m² every 21 days along with radiotherapy, and a further 27 patients who had outpatient weekly cisplatin at 40 mg/m² concomitant with radiotherapy.
After controlling for stage, 3-year progression-free survival was 90% in the 5-day group and 76% in the weekly group, a significant difference.
In addition, adjusting for stage, age, and completion of treatment, the risk of treatment failure among the weekly group was 3.46 times higher than that in the 5-day group. The weekly group also had a 3.43 times higher risk of developing acute toxicities than the 5-day group.
"We found," continued Dr. Einstein, "that the way most of us who treat cervical cancer in this country are currently administering chemotherapy -- as an outpatient -- imparts worse survival and more toxicity than the way we used to administer cisplatin -- as an inpatient -- over 5 days."
"We believe," he concluded, "these important findings merit a prospective, randomized trial to determine if a true difference between these two chemotherapy regimens exists."
Cancer 2007;109:48-53.